Document resource
Background Most current studies on Onyx are limited by small sample sizes and often involve its use in combination with other embolic materials, with few investigations specifically evaluating Onyx as a sole embolic agent.Methods Using the Dural Arteriovenous Fistula Research and Management in China (DREAM-INI) database, we identified patients who underwent primary treatment for dural arteriovenous fistula (DAVF) with Onyx-only embolisation. Data collected included patient demographics, comorbidities, clinical manifestations, DAVF location, arterial supply, Borden and Cognard classifications, endovascular modalities, angiographic results, complications, and both clinical and angiographic follow-up. Multivariate logistic regression analyses were conducted to identify predictors of immediate complete obliteration, complications and poor clinical outcomes.Results A total of 471 patients with DAVFs underwent primary embolisation using Onyx. The median duration of clinical follow-up was 35.0 months (IQR 10.0–75.3), while the median angiographic follow-up was 24.0 months (IQR 8.0–63.0). Immediate complete obliteration was achieved in 417 patients (88.5%). Procedure-related complications occurred in 31 cases (6.6%). At the final follow-up, 90.6% of patients demonstrated good clinical outcomes. Borden type III DAVFs were positively associated with immediate complete obliteration, whereas the presence of occipital and pial artery feeders was negatively associated. Tentorial location correlated with a higher risk of complications, and age above 65 years emerged as a significant predictor of poor clinical outcome.Conclusions In this large single-centre study based on the DREAM-INI database, we report satisfactory obliteration rates, a low incidence of complications and favourable outcomes following Onyx-based single-agent primary embolisation for single DAVFs.